Medication overuse headache: Treatment and prognosis
- Ivan Garza, MD
Ivan Garza, MD
- Assistant Professor of Neurology
- Mayo Clinic College of Medicine
- Todd J Schwedt, MD, MSCI
Todd J Schwedt, MD, MSCI
- Professor of Neurology
- Mayo Clinic
Chronic daily headache is a descriptive term that encompasses several different specific headache diagnoses. Chronic daily headache types of long duration (ie, four hours or more) include chronic migraine, chronic tension-type headache, medication overuse headache, hemicrania continua, and new daily persistent headache.
Medication overuse headache (MOH) is a common problem in clinical practice that needs to be properly managed in order to increase the likelihood of successful chronic daily headache treatment.
This topic will review the treatment and prognosis of MOH. Other clinical aspects of MOH are discussed elsewhere. (See "Medication overuse headache: Etiology, clinical features, and diagnosis".)
The remaining subtypes of chronic daily headache are reviewed separately. (See "Overview of chronic daily headache".)
Withdrawal of the overused medication as soon as possible is the treatment of choice for medication overuse headache (MOH) . It is also important to educate patients about the detrimental effects of analgesic overuse. Bridge (transitional) therapy may be useful during drug withdrawal to provide symptomatic relief. For most patients, a preventive (prophylactic) medication aimed at the suspected background primary headache disorder (eg, migraine) should be initiated either during or immediately following withdrawal . Screening and intervening for comorbid psychiatric and substance use disorders is also recommended [2,3].
- Abrams BM. Medication overuse headaches. Med Clin North Am 2013; 97:337.
- Boes CJ, Black DF, Dodick DW. Pathophysiology and management of transformed migraine and medication overuse headache. Semin Neurol 2006; 26:232.
- Dodick D, Freitag F. Evidence-based understanding of medication-overuse headache: clinical implications. Headache 2006; 46 Suppl 4:S202.
- Mathew NT, Kurman R, Perez F. Drug induced refractory headache--clinical features and management. Headache 1990; 30:634.
- Rossi P, Di Lorenzo C, Faroni J, et al. Advice alone vs. structured detoxification programmes for medication overuse headache: a prospective, randomized, open-label trial in transformed migraine patients with low medical needs. Cephalalgia 2006; 26:1097.
- Diener HC, Limmroth V. Medication-overuse headache: a worldwide problem. Lancet Neurol 2004; 3:475.
- Zeeberg P, Olesen J, Jensen R. Discontinuation of medication overuse in headache patients: recovery of therapeutic responsiveness. Cephalalgia 2006; 26:1192.
- Katsarava Z, Jensen R. Medication-overuse headache: where are we now? Curr Opin Neurol 2007; 20:326.
- Obermann M, Katsarava Z. Management of medication-overuse headache. Expert Rev Neurother 2007; 7:1145.
- Freitag FG, Lake A 3rd, Lipton R, et al. Inpatient treatment of headache: an evidence-based assessment. Headache 2004; 44:342.
- Young W, Silberstein S, Nahas S, Marmura M. Jefferson Headache Manual, Demos Medical Publishing, New York 2010.
- Katsarava Z, Fritsche G, Muessig M, et al. Clinical features of withdrawal headache following overuse of triptans and other headache drugs. Neurology 2001; 57:1694.
- Mathew NT. Amelioration of ergotamine withdrawal symptoms with naproxen. Headache 1987; 27:130.
- Pascual J, Berciano J. [Daily chronic headache in patients with migraine induced by abuse of ergotamine-analgesics: response due to a protocol of outpatient treatment]. Neurologia 1993; 8:212.
- Smith TR. Low-dose tizanidine with nonsteroidal anti-inflammatory drugs for detoxification from analgesic rebound headache. Headache 2002; 42:175.
- Bøe MG, Mygland A, Salvesen R. Prednisolone does not reduce withdrawal headache: a randomized, double-blind study. Neurology 2007; 69:26.
- Rabe K, Pageler L, Gaul C, et al. Prednisone for the treatment of withdrawal headache in patients with medication overuse headache: a randomized, double-blind, placebo-controlled study. Cephalalgia 2013; 33:202.
- Pageler L, Katsarava Z, Diener HC, Limmroth V. Prednisone vs. placebo in withdrawal therapy following medication overuse headache. Cephalalgia 2008; 28:152.
- Diener HC. How to treat medication-overuse headache: prednisolone or no prednisolone? Neurology 2007; 69:14.
- Young WB. Medication Overuse Headache. Curr Treat Options Neurol 2001; 3:181.
- Rozen TD. Migraine Headache: Immunosuppressant Therapy. Curr Treat Options Neurol 2002; 4:395.
- Krymchantowski AV, Barbosa JS. Prednisone as initial treatment of analgesic-induced daily headache. Cephalalgia 2000; 20:107.
- Silberstein SD, Saper JR, Freitag FG. Migraine: diagnosis and treatment. In: Wolff's Headache and Other Head Pain, Silberstein SD, Lipton RB, Dalessio DJ (Eds), Oxford University Press, New York 2001. p.121.
- Silberstein SD. Practice parameter: evidence-based guidelines for migraine headache (an evidence-based review): report of the Quality Standards Subcommittee of the American Academy of Neurology. Neurology 2000; 55:754.
- Raskin NH. Repetitive intravenous dihydroergotamine as therapy for intractable migraine. Neurology 1986; 36:995.
- Silberstein SD, Schulman EA, Hopkins MM. Repetitive intravenous DHE in the treatment of refractory headache. Headache 1990; 30:334.
- Ford RG, Ford KT. Continuous intravenous dihydroergotamine in the treatment of intractable headache. Headache 1997; 37:129.
- Lu SR, Fuh JL, Juang KD, Wang SJ. Repetitive intravenous prochlorperazine treatment of patients with refractory chronic daily headache. Headache 2000; 40:724.
- Williams DR, Stark RJ. Intravenous lignocaine (lidocaine) infusion for the treatment of chronic daily headache with substantial medication overuse. Cephalalgia 2003; 23:963.
- Schwartz TH, Karpitskiy VV, Sohn RS. Intravenous valproate sodium in the treatment of daily headache. Headache 2002; 42:519.
- Weatherall MW, Telzerow AJ, Cittadini E, et al. Intravenous aspirin (lysine acetylsalicylate) in the inpatient management of headache. Neurology 2010; 75:1098.
- Evers S, Jensen R, European Federation of Neurological Societies. Treatment of medication overuse headache--guideline of the EFNS headache panel. Eur J Neurol 2011; 18:1115.
- Chiang CC, Schwedt TJ, Wang SJ, Dodick DW. Treatment of medication-overuse headache: A systematic review. Cephalalgia 2016; 36:371.
- Kossoff EH, Mankad DN. Medication-overuse headache in children: is initial preventive therapy necessary? J Child Neurol 2006; 21:45.
- Munksgaard SB, Bendtsen L, Jensen RH. Detoxification of medication-overuse headache by a multidisciplinary treatment programme is highly effective: a comparison of two consecutive treatment methods in an open-label design. Cephalalgia 2012; 32:834.
- Diener HC. Detoxification for medication overuse headache is not necessary. Cephalalgia 2012; 32:423.
- Hagen K, Albretsen C, Vilming ST, et al. Management of medication overuse headache: 1-year randomized multicentre open-label trial. Cephalalgia 2009; 29:221.
- Hagen K, Stovner LJ. A randomized controlled trial on medication-overuse headache: outcome after 1 and 4 years. Acta Neurol Scand Suppl 2011; :38.
- Diener HC, Bussone G, Van Oene JC, et al. Topiramate reduces headache days in chronic migraine: a randomized, double-blind, placebo-controlled study. Cephalalgia 2007; 27:814.
- Silberstein SD, Lipton RB, Dodick DW, et al. Efficacy and safety of topiramate for the treatment of chronic migraine: a randomized, double-blind, placebo-controlled trial. Headache 2007; 47:170.
- Diener HC, Dodick DW, Goadsby PJ, et al. Utility of topiramate for the treatment of patients with chronic migraine in the presence or absence of acute medication overuse. Cephalalgia 2009; 29:1021.
- Aurora SK, Dodick DW, Turkel CC, et al. OnabotulinumtoxinA for treatment of chronic migraine: results from the double-blind, randomized, placebo-controlled phase of the PREEMPT 1 trial. Cephalalgia 2010; 30:793.
- Diener HC, Dodick DW, Aurora SK, et al. OnabotulinumtoxinA for treatment of chronic migraine: results from the double-blind, randomized, placebo-controlled phase of the PREEMPT 2 trial. Cephalalgia 2010; 30:804.
- Dodick DW, Turkel CC, DeGryse RE, et al. OnabotulinumtoxinA for treatment of chronic migraine: pooled results from the double-blind, randomized, placebo-controlled phases of the PREEMPT clinical program. Headache 2010; 50:921.
- Silberstein SD, Blumenfeld AM, Cady RK, et al. OnabotulinumtoxinA for treatment of chronic migraine: PREEMPT 24-week pooled subgroup analysis of patients who had acute headache medication overuse at baseline. J Neurol Sci 2013; 331:48.
- Garza I, Swanson JW. Answers to frequently asked questions about migraine. Mayo Clin Proc 2006; 81:1387.
- Zidverc-Trajkovic J, Pekmezovic T, Jovanovic Z, et al. Medication overuse headache: clinical features predicting treatment outcome at 1-year follow-up. Cephalalgia 2007; 27:1219.
- Katsarava Z, Muessig M, Dzagnidze A, et al. Medication overuse headache: rates and predictors for relapse in a 4-year prospective study. Cephalalgia 2005; 25:12.
- Zeeberg P, Olesen J, Jensen R. Efficacy of multidisciplinary treatment in a tertiary referral headache centre. Cephalalgia 2005; 25:1159.
- PATIENT EDUCATION
- WITHDRAWAL OF THE OVERUSED MEDICATION
- Outpatient and inpatient strategies
- Withdrawal symptoms
- BRIDGE THERAPY
- Tizanidine plus nonsteroidal anti-inflammatory drugs
- - Protocols
- - Side effects and contraindications
- PREVENTIVE THERAPY
- FOLLOW-UP AND RELAPSE PREVENTION
- INFORMATION FOR PATIENTS
- SUMMARY AND RECOMMENDATIONS